Colposcopy as an adjunctive diagnostic tool in the
assessment of cervical intraepithelial neoplasia is a significant aid
to the pelvic surgeon in selecting the appropriate method of therapy
in certain cases. Its use is indicated in all patients having abnormal
Papanicolaou cytologic smears or gross lesions.

To obtain accurate cytologic
specimens for study, the surgeon must be trained not only in performing
a colposcopy but also in selecting the proper instruments for the examination.

The purpose of the operation
is to visualize the cervix under high magnification and delineate abnormal
zones of cervical epithelium. In addition, it is designed to allow
precise, accurate biopsies to be obtained from these abnormal zones
of epithelium.

Physiologic Changes. None.

Points of Caution. A direct Papanicolaou smear should
be taken prior to any manipulation of the cervix.

A detailed survey of the cervix should be performed prior to any surgical
manipulation.

Directed biopsies, oriented to prevent tangential cutting,
should be placed on small pieces of wet paper towel and sent to the
pathologist.

Technique

The patient is placed on an
ordinary gynecologic examining table, and a nonlubricated speculum
is placed in the vagina. The colposcope is moved into appropriate
position and focused. A routine cytologic smear as well as a
wet mounted smear for Trichomonas and Monilia are
taken. The cervical mucus is then cleared by applying 4% acetic
acid to the cervix and removing the solution with either a small
suction cannula or a cotton-tipped applicator. The cervix is
studied carefully with the green filter lens in place to enhance
the appearance of the cervical blood vessels.

Appropriate biopsy instruments, designed
for taking crisp, sharp, directed biopsies from zones of abnormal
tissue located by the colposcope, are selected.

An endocervical speculum is inserted to appropriately
inspect the endocervical canal.

Because there are
significant patterns important to the diagnosis of cervical intraepithelial
neoplasia, the surgeon searches specific zones for signs of abnormal
epithelium.